Study of Cardiac Lymph with Special Reference to Cardiac Surgery

本文从外科病理生理学的角度，对犬心肌缺血与心脏淋巴液的关系进行了实验研究。在以往的研究中，我们已经阐明了缺血心肌与心肌淋巴液生成的密切关系。本系列实验旨在分析心肌淋巴液动态变化对缺血心肌的影响机制。本实验观察了心肌淋巴液的引流情况，并通过控制冠脉血流量的方法，对心肌缺血进行了观察，初步认识到心肌梗死面积与心肌淋巴液的产生量有显著相关性（P <0.01）。在心肌缺血的病例中也观察到心肌水肿。然后，实验针对从死于缺血的心肌中主动引流心脏淋巴。为此，静脉注射透明质酸酶。 ...更多信息 y.结果满意，心脏淋巴量增加。我们将通过冠状动脉血管闭塞排除冠状动脉血流的区域定义为“风险因子：R），将完成心肌梗死的区域定义为“梗死区域：I）。后一区域通过TTC染色病理学证实。通过面积测量法比较两个区域之间的程度，使用透明质酸酶后I/R比率显著降低。左心室质量的数据为33.5 <plus-minus>± 12.3% vs. 11.1 ± 12.3%<plus-minus>（p &lt;0.00u）。这一现象证明了心脏淋巴液的主动引流对缺血心肌的修复起着重要作用。接下来，为了明确冠状动脉的流量与心脏淋巴体积之间的关系，产生AC旁路以任意管理冠状动脉血流量。用氢气清除法测定缺血心肌局部血流量。冠状动脉血流量减少至对照组的50%时，心脏淋巴液流量并未减少，但局部心肌血流量明显减少（33.4%比29.8%）。然而，在使用透明质酸酶的情况下，结果似乎与该结果完全不同。缺血前后心内膜和心外膜的心肌细胞凋亡率分别为8.5%和3.0%。这是一个有意义的结果，证明了心肌缺血时心脏淋巴液的作用，以及心脏淋巴液主动引流对预防心肌缺血性损伤的重要性Less

The relationship between myocardial ischemia and cardiac lymph has been studied experimentally in dogs from the point of view of surgical pathophysiology. In previous study we have clarified the close relationship between ischemic myocardium and cardiac lymph production. The present series of experimental study has been prepared for analysis of the mechanism in which the ischemic myocardium is influenced by dynamical change of the cardiac lymph. The experimental study sonsists of the observation of cardiac lymph drainage and the measures for myocardial ischemia by means of control of the coronary blood flow.In the first step we recognized the fact that the extent of the area of infarction significantly correlated to the production of cardiac lymph(p 0.01). Myocardial edema was also seen in cases with myocardial ischemia. The experiment was then directed to active drainage of cardiac lymph from the myocardium succumbed to ischemia. For this purpose, hyaluronidase was given intra-venousl … More y. The result was satisfactory with increased cardiac lymph volume. We defined the area excluded from coronary flow by means of occlusion of the coronary vessel as "risk factor : R) and the area completed myocardial infarction as "infarcted area : I). The latter area was confirmed pathologically by TTC staining. In comparison of the extent between both areas by means of planimetry, the ratio of I/R significantly decreased a fter the use of hyaluronidase. The data was 33.5<plus-minus>12.3% of the left ventricular ma ss vs. 11.1<plus-minus>12.3%(p 0.00u). This phenomenon was a proof that an active drainage of cardiac lymph played an important role to selvage the ischemic myocardium. In the next, for the purpose to clarify the relationship between the flow volume of the coronary artery and the cardiac lymph volume, AC-bypass was produced for arbitrary management of the volume of the coronary blood flow. Besides, regional myocardial blood flow on the ischemic myocardium was measured using hydrogen gas clearance method. Reduction of the coronary flow to 50% of the control did not reduced the cardiac lymph flow but the regional myocardial blood flow in prominence with endocardium than epicardium (33.4% vs. 29.8%) . However in cases with hyaluronidase the result was appeared completely differed from this result. There was insignificant change between pre and post ischemia revealing 8.5% in the endocardium and only 3.0% in the epicardium, respectively. This is a significant result that prove the role of cardiac lymph under myocardial ischemia and the importance of active drainage of cardiac lymph for prevention of an ischemic damage of the myocard Less